Get the free Medical Surveillance, Referral and Approval Form - Florida Atlantic ... - fau

Medical Surveillance, Referral and Approval Form Florida Atlantic University EHOS: (561) 297-3129 Employee Name: Supervisor: Referral For: (Check all that apply) Animal Contact NRC guideline Medical

How to fill out medical surveillance referral and

How to fill out medical surveillance referral:

1. Obtain the necessary forms: Identify the specific medical surveillance referral form required by your organization or healthcare provider.
2. Fill in personal information: Provide your full name, date of birth, contact information, and any other requested personal details.
3. Specify reason for referral: Clearly state the reason for the medical surveillance referral, whether it is due to occupational exposure, health concerns, or other factors.
4. Include relevant medical history: Provide a comprehensive medical history, including any previous diagnoses, treatments, surgeries, medications, allergies, and family medical history.
5. Attach supporting documents: If applicable, include any relevant medical reports, test results, or referrals from other healthcare professionals.
6. Sign and date the referral: Ensure that you sign and date the referral form, acknowledging your consent and understanding of the information provided.

Who needs medical surveillance referral:

1. Employees in certain industries: Various industries, such as healthcare, construction, and manufacturing, may require employees to undergo medical surveillance to monitor their health and assess any work-related risks.
2. Individuals with potential occupational exposures: Those who may be exposed to hazardous substances, infectious agents, noise, radiation, or other occupational hazards may require medical surveillance to ensure their health and safety.
3. Individuals with specific health concerns: People with specific health conditions or symptoms, such as respiratory problems or suspected work-related illnesses, may benefit from medical surveillance referrals to further assess their health status.

For pdfFiller’s FAQs

What is medical surveillance referral?

Medical surveillance referral is a process where an individual is referred to a medical professional or healthcare provider for further evaluation or examination due to potential health risks or concerns.

Who is required to file medical surveillance referral?

Employers are typically required to file medical surveillance referral in order to ensure the health and safety of their employees.

How to fill out medical surveillance referral?

To fill out a medical surveillance referral, the employer or designated person should provide relevant information about the employee's job responsibilities, potential exposures, and any signs or symptoms of health issues.

What is the purpose of medical surveillance referral?

The purpose of medical surveillance referral is to detect and prevent potential occupational health issues in employees, ensuring their well-being and compliance with applicable regulations.

What information must be reported on medical surveillance referral?

Medical surveillance referral should include information such as the employee's name, job title, relevant exposures or hazards, reason for referral, and any available medical records or test results.

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